Section 97931.03 - Application; Process(a) A physician who desires to participate in the program shall submit an application to the program on a form prescribed by the program that includes all of the following: (1) Applicant's name, address, telephone numbers, social security number, date of birth, date on which first medical license was issued and name of issuing body, and, if available, e-mail address.(2) Which of the criteria listed in Section 128553(c) of the code or in section 97931.02 the applicant meets and why, including dates of and institutions where postgraduate training or fellowships occurred.(3) A statement as to why the physician wants to participate in the program.(4) The name of each lender from which the applicant has obtained an educational loan, together with a current loan statement that contains the lender's name and mailing address, the applicant's name and loan account number, the outstanding balance of the loan, and the date on which the loan statement was issued.(5) Whether the applicant has ever been in default or had a judgment lien against the applicant for any debt, and an explanation for each default or judgment lien.(6) Whether the applicant is willing to sign or has signed a written agreement with the practice setting(s) committing to three years of full-time service in a medically underserved area.(7) The name and address of each practice setting at which services are to be provided under the program.(8) A certification under penalty of perjury as to the contents of the application and any attachments, signed and dated by the applicant.(9) A statement authorizing release to the program of information enumerated in the application and any attachments thereto.(10) A certification under penalty of perjury, signed and dated by the practice setting's administrative officer, whose name is printed below his/her signature, that the facility has entered into an agreement with the applicant for a minimum of three years; that the applicant can speak a Medi-Cal threshold language; that it will pay the applicant a prevailing wage and not offset any loan repayments by the program against the applicant's salary; and that it is a "practice setting" as defined in Section 128552(i) of the code.(b) Application filing periods will be dependent upon available funding and the number of openings in the program. Every application filing period shall be posted on the Office's Web site and shall close not earlier than 30 days after the date on which openings are first posted on the Office's Web site. Notwithstanding section 97931.04(a), an application that is either not complete or not received by the final filing date shall not be considered but shall be returned to the applicant.(c) A participating physician shall sign a written agreement with the Office committing to all terms of the program and acknowledging that loan repayment will be made in accordance with Section 128556. If (1) a participating physician ceases full-time practice; or (2) both the practice setting and the physician have agreed to termination of the physician's employment, and the physician has been successful in obtaining subsequent qualifying employment within 3 months after termination of employment, loan repayment will be reduced proportionately by the time spent away from qualifying practice during that contract year.(d) If a physician participating in the program receives a loan repayment of less than $105,000, 24 percent of the loan repayment amount will be made at the end of the first year, 33 percent at the end of the second year, and 43 percent at the end of the third year.Cal. Code Regs. Tit. 22, § 97931.03
1. Change without regulatory effect renumbering title 16, section 1313.03 to title 22, section 97931.03 (including amendment of section and NOTE) filed 6-25-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 26). Note: Authority cited: Section 128554, Health and Safety Code. Reference: Sections 128553 and 128556, Health and Safety Code.
1. New section filed 4-25-2003 as an emergency; operative 4-25-2003 (Register 2003, No. 17). A Certificate of Compliance must be transmitted to OAL by 8-25-2003 or emergency language will be repealed by operation of law on the following day.
2. Certificate of Compliance as to 4-25-2003 order transmitted to OAL 8-19-2003 and filed 9-30-2003 (Register 2003, No. 40).
3. Change without regulatory effect renumbering title 16, section 1313.03 to title 22, section 97931.03 filed 6-25-2015 pursuant to section 100, title 1, California Code of Regulations (Register 2015, No. 26).